Engineering for quality in the postanesthesia care unit: an outcomes approach.

For the past 18 months, we have been monitoring three categories of outcome indicators. This process has aided us in decreasing overall patient length of stay (LOS) and improved the quality of care we provide our PACU patients. Using a local area network (LAN) computer program, we track the following: a set of sentinel indicators, a set of proximate clinical outcome indicators, and a set of system indicators based on nonclinical issues that prolong PACU LOS. The LAN computer program links the surgical scheduling department, OR, and PACU, and aids in accurately compiling and collating data. Quality improvement tools to facilitate further scrutiny of processes and aspects of care felt to be of particular relevance to perioperative nursing have also been developed. We are entering an era in which external accrediting agencies and third-party payers are placing an increasing emphasis on measuring and optimizing patient outcomes. This overall program will position the PACU at an advantage in meeting such challenges.